Category: Nevin Manimala

BMC Health Serv Res. 2025 Aug 23;25(1):1122. doi: 10.1186/s12913-025-13162-1.

ABSTRACT

BACKGROUND: Globally, maternal and child health outcomes were negatively affected during the COVID-19 pandemic. There is limited qualitative evidence focused on access to maternal health services during the COVID-19 pandemic in rural sub-Saharan African populations. This study aims to fill this gap by exploring key community perspectives on access to maternal health services during the COVID-19 pandemic in rural western Kenya.

METHODS: We conducted five focus group discussions and sixty one in-depth interviews. Participants were mothers who delivered in 2020 during the acute phase of the COVID-19 pandemic and rural community health workers (CHWs) in Siaya and Kisii counties. The three-delay model framework helped to guide discussions around access to maternal health services during the COVID-19 pandemic in rural western Kenya. We transcribed the data and conducted a thematic content analysis.

RESULTS: According to CHWs and expectant mothers, fear and misconceptions about COVID-19 were associated with delays in making the decision to seek maternal health care. Lockdowns, movement restrictions, and curfews made it challenging to physically reach health facilities. The shortage of drugs and supplies and an insufficient number of healthcare workers in health facilities were barriers to care seeking. The quality of maternal health services was perceived to have declined during the COVID-19 pandemic. Mothers reported the Linda Mama health insurance program helped them pay for maternal health services during the COVID-19 pandemic; however, out-of-pocket expenses were common. As reported by mothers, CHWs when engaged and active, helped alleviate access challenges by serving as a link to the health system. There were significant socio-economic difficulties experienced by community members because of closed businesses and schools.

CONCLUSIONS: Community perspectives revealed significant challenges with accessing maternal health services during the COVID-19 pandemic in rural western Kenya. The pandemic amplified each of three delays in accessing care leading to poorer access to maternal health services. The overriding perception among mothers was that CHWs helped mitigate challenges around access to health services. CHWs should be included in future pandemic preparedness and response efforts.

PMID:40849655 | DOI:10.1186/s12913-025-13162-1

BMC Womens Health. 2025 Aug 23;25(1):404. doi: 10.1186/s12905-025-03952-4.

ABSTRACT

BACKGROUND: Serum levels of anti-Mullerian hormone (AMH), a key indicator of ovarian aging, decrease with age. This decline may be accelerated by genetic and environmental factors. Accordingly, the present study investigates the relationship between serum AMH concentrations and exposure to heavy metals.

METHODS: This cohort study was conducted on 220 women with a median age of 42 years (Range: 37-45). Participants were reproductive-age women from the Tehran Lipid and Glucose Study (TLGS) that met our inclusion criteria. Serum concentration of heavy metals – including lead (Pb), cadmium (Cd), copper (Cu), aluminum (Al) and chromium (Cr) – as well as AMH levels, were measured using stored samples from the second and fifth follow-up visits with a time interval of approximately 10 years. A multivariate linear regression model was used to assess the relationship between AMH and heavy metals, adjusting for age, body mass index (BMI), smoking, physical activity, age at menarche, education, marital status and parity.

RESULTS: The results indicated that serum AMH concentration in women classified within the fourth and third quartiles of Cu was reduced by -0.43 (95%CI: -0.73, -0.13) ng/ml and – 0.34 (95%CI: -0.65, -0.03) ng/ml, respectively. No statistically significant associations were observed between AMH levels and other heavy metals, including Pb, Al, and Cr (P > 0.05).

CONCLUSION: These findings suggest a possible link between elevated Cu levels and diminished AMH concentrations in reproductive-age women. However, further research is needed to confirm these findings and to elucidate the underlying factors, particularly in younger age groups.

PMID:40849647 | DOI:10.1186/s12905-025-03952-4

BMC Musculoskelet Disord. 2025 Aug 23;26(1):815. doi: 10.1186/s12891-025-09086-w.

ABSTRACT

OBJECTIVE: To investigate the relationships among the acromial tilt (AT), the glenoid inclination angle (GIA), the critical shoulder angle (CSA), the acromioglenoid angle (AGA), and degenerative rotator cuff injury via digital reconstruction radiographs (DRRs).

METHODS: A retrospective cohort of 63 patients who met the inclusion criteria were enrolled from the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between April 2023 and April 2024, 33 patients with rotator cuff injury and 30 controls were included. Clinical data and scapular computed tomography (CT) scans were collected, and three-dimensional reconstructions were generated via Amira software (Thermo Fisher Scientific, USA). Digital reconstruction radiograph (DRR) images were simulated at the Grashey and Y positions of the scapula, and the parameters were measured via Digimizer software (MedCalc Software, Belgium). The diagnostic and predictive validity of each parameter for DRR for rotator cuff injury was assessed through statistical analysis of the measured data, including inter-observer consistency, correlation analysis among parameters, and receiver operating characteristic (ROC) curve analysis.

RESULTS: (1) Inter-observer reliability was excellent for all the parameters (intra-class correlation coefficient (ICC) > 0.8). (2) CSA and AGA were significantly greater in the rotator cuff injury group (P_CSA= 0.003;P_AGA < 0.001), whereas GIA was significantly lower (P < 0.001); no difference was detected in AT (P > 0.05). (3) Binary logistic regression analysis revealed that GIA, CSA, and AGA were risk factors for rotator cuff injury (P_CSA=0.008; P_AGA = 0.001; P_GIA = 0.001). (4) ROC analysis yielded area under the curve (AUC) values of 0.755 (GIA), 0.700 (CSA), and 0.796 (AGA), with cutoff thresholds of 83.98°, 30.67°, and 42.04°, respectively. (5) Strong correlations were observed between the CSA and AGA (r = 0.939), whereas the GIA was inversely correlated with both the CSA (r = -0.423) and the AGA (r = -0.471).

CONCLUSION: Measurements of GIA, CSA, and AGA derived from DRRs demonstrate high diagnostic value for degenerative rotator cuff injury. DRR represents a reliable alternative to conventional radiography in clinical practice. In the future, DRR holds promise as a tool for assessing the impact of degenerative rotator cuff injury. However, due to radiation exposure concerns, the current application of DRR is recommended primarily for retrospective studies utilizing existing computed tomography (CT) data.

PMID:40849641 | DOI:10.1186/s12891-025-09086-w

Adv Simul (Lond). 2025 Aug 23;10(1):43. doi: 10.1186/s41077-025-00374-y.

ABSTRACT

BACKGROUND: Simulation is widely used across many aspects of health professions education and, in recent years, has begun to be explored as an assessme nt tool, particularly in relation to examining technical clinical skills. Although previous research has suggested that simulation may be an effective tool for assessing clinical skills, there is a lack of evidence exploring which form of technology may be a more reliable assessment tool. This crossover study aimed to compare two forms of simulation technology-a high-fidelity manikin and virtual reality, as potential tools for assessing acute clinical care assessment skills.

METHODS: The participating students completed two different simulation scenarios: one scenario using a high-fidelity manikin and one using a virtual reality system. The two scenarios were then marked using a checklist created for the research and a global assessment score. The results for each simulation technology were compared with one another and compared with the participants’ medical final summative assessment scores.

RESULTS: Sixteen students participated in the research. The assessment checklist scores from the two technologies were comparable, with no statistically significant difference (p = 0.918) and a strong positive correlation between the two (correlation coefficient = 0.665, p = 0.005). However, neither simulation technology had a statistically significant correlation with the summative final written examination paper (high-fidelity manikin: correlation coefficient = – 0.25, p = 0.927; virtual reality: correlation coefficient = 0.363, p = 0.167) or final clinical examination scores (high-fidelity manikin: correlation coefficient = – 0.204, p = 0.449; virtual reality: correlation coefficient = – 0.201, p = 0.455).

CONCLUSIONS: The findings from this research suggest that virtual reality simulation is comparable to high-fidelity simulation when comparing student scores across the two forms of simulation. However, neither method demonstrated a strong correlation with final summative examination outcomes, suggesting that a single scenario assessment using either technology may not provide an appropriate alternative to existing final summative examinations. To better understand the role of simulation in assessment, further research is needed to compare these two simulation technologies in more depth and provide additional evidence to support educators in understanding how they can be best used within health professions education.

PMID:40849636 | DOI:10.1186/s41077-025-00374-y

J Orthop Surg Res. 2025 Aug 23;20(1):795. doi: 10.1186/s13018-025-06195-z.

ABSTRACT

BACKGROUND: Functional ankle instability (FAI) is a common chronic disease after ankle sprains, and exercise intervention can improve symptoms of instability. This research aims to assess the effect of two new ankle balance device training programs on the ankle function and postural control ability in individuals with functional ankle instability.

METHODS: A total of sixty-eight participants with FAI were randomly assigned to three groups: the spherical ankle balance device (SABD) group, the ensiform ankle balance device (EABD) group and the control group. Participants in all three groups engaged in an 8-week exercise intervention, conducting 4 times per week, each lasting 30 min. Variables were assessed before and after the intervention immediately, including the CAIT score, peroneal muscle reaction time, joint position sense, ankle inversion and eversion torques, and postural control ability. A paired t-test was utilized to compare results within each group, while one-way ANOVA was applied for comparisons between groups. Stepwise regression analysis was performed using the changes in CAIT score post-training as the dependent variable, with changes in peroneal muscle reaction time, position sense, postural control ability, and ankle torque as independent variables to establish a regression equation. A p-value of less than 0.05 was considered to indicate statistically significant differences.

RESULTS: After eight weeks of intervention, the SABD and EABD groups exhibited significant reductions in peroneal muscle reaction time (P < 0.05) and increases in ankle eversion torque (P < 0.05) compared to the control group. The EABD group demonstrated superior outcomes in ankle inversion and eversion torque and postural control compared to SABD groups (P < 0.05).

CONCLUSION: Training with new ankle balance devices significantly enhanced postural control and ankle function in patients with FAI, especially for ensiform ankle balance device.

TRIAL REGISTRATION: Current Controlled Trials ChiCTR2500107096, 20,250,804 (Retrospectively registered).

PMID:40849635 | DOI:10.1186/s13018-025-06195-z

J Orthop Surg Res. 2025 Aug 23;20(1):794. doi: 10.1186/s13018-025-05805-0.

ABSTRACT

BACKGROUND: Knee osteoarthritis (OA) is a prevalent condition influenced by various biochemical, anatomical, and lifestyle factors. Vitamin D deficiency has been implicated in OA, but its role in disease severity and associated symptoms remains unclear. We aimed to investigate the prevalence of vitamin D deficiency in knee OA patients and its relationship with inflammatory markers and clinical symptoms.

METHODS: This retrospective study analyzed 986 patients with knee OA over a 3.5-year period. Vitamin D levels, ESR, and platelet counts were assessed, along with demographic and clinical data. Statistical analyses were conducted to explore associations.

RESULT: This study involved 986 patients with knee OA, majority of them (85% ) were female with mean age 52.95 ± 12.44 years. More than half of patients 59.7% had unilateral knee OA and 40.3% had bilateral knee OA. The mean value of Vitamin D3 was 25.35 ± 14.125. Vitamin D deficiency was observed in 70.9% of patients, with moderate deficiency being most prevalent (36.94%). No significant association was found between vitamin D levels and inflammatory markers. However, a strong association was observed between vitamin D deficiency and symptoms like polyarthralgia (p < .05)., Bilateral OA was associated with higher vitamin D deficiency levels compared to unilateral OA (P < .001).

CONCLUSION: OA more prevalence among female .As well as, vitamin D deficiency is highly prevalent in knee OA patients and its severity associated with Bilateral OA and polyarthralgia but not with inflammatory markers. Future research should focus on the long-term impact of vitamin D supplementation and the molecular mechanisms underlying these disparities.

PMID:40849628 | DOI:10.1186/s13018-025-05805-0

BMC Womens Health. 2025 Aug 23;25(1):406. doi: 10.1186/s12905-025-03940-8.

ABSTRACT

BACKGROUND: Menstrual symptoms are a prevalent and frequently encountered woman’s health condition. This study aimed to examine the effect of exercise on menstrual symptoms, sleep quality, fatigue, and physical activity levels.

METHODS: The study was designed as a randomized controlled trial between September 2023 and December 2023. The study included 54 women aged 18 to 45 years. The participants were allocated to the exercise or the control group using simple randomization with a sealed envelope method. All participants were evaluated with the Menstrual Symptom Questionnaire (MSQ), the Menstrual Distress Questionnaire (MDQ), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire-Short Form (IPAQ) before and after treatment. The control group did not receive an exercise program. The exercise group received strengthening, flexibility, and balance exercises. A moderate-intensity aerobic exercise and walking program was implemented at least three days per week. The study spanned three menstrual cycles for each woman and lasted an average of 12 weeks.

RESULTS: Within-group analysis showed a significant decrease in MSQ (p=0.001), MDQ (menstrual) (p=0.002), FSS (p=0.003), and PSQI (p=0.001) scores after exercise. In contrast, the IPAQ score increased significantly in the exercise group p=0.001). In the control group, a significant decrease was observed only in the MDQ (intermenstrual) score (p=0.915). A comparison of the pre-treatment and post-treatment changes in the exercise and control groups revealed a significant decrease in MSQ (p=0.001), MDQ (menstrual) (p=0.023), and PSQI scores (p=0.001) and an increase in IPAQ scores (p=0.001) in the exercise group compared to the control group. However, the decrease in MDQ (pre-menstrual and intermenstrual) (p=0.626^, p=0.348) and FSS scores (p=0.102) were not statistically different between the groups.

CONCLUSIONS: In conclusion, exercise can decrease the menstrual symptoms in women with menstrual symptoms as a primary outcome. Second, exercise can also increase their sleep quality. Therefore, it can be employed as a non-pharmacological adjuvant method to help women manage their symptoms.

TRIAL REGISTRATION: The protocol is registered with http://clinicaltrials.gov/ (17/August/2023, Clinical Trial, NCT06006507).

PMID:40849627 | DOI:10.1186/s12905-025-03940-8

BMC Cardiovasc Disord. 2025 Aug 23;25(1):628. doi: 10.1186/s12872-025-04974-4.

ABSTRACT

BACKGROUND: Mitral regurgitation (MR) presents either as primary or secondary, with options for surgical or transcatheter repair. Thromboembolic risks following surgery are significant despite the use of antithrombotic medications, and guidelines for postoperative anticoagulation therapy lack consistency. This systematic review aims to compare antithrombotic medications after mitral valve repair (MVR). In this study, we intend to compare antithrombotic medications after MVR.

MATERIALS AND METHODS: The study followed the Cochrane handbook and PRISMA guidelines. We systematically searched databases (PubMed, Scopus, Ovid, Cochrane, Web of Science) until June 2024 for TMVR studies using specific criteria. Quality assessment utilized the Newcastle-Ottawa scale. Data extraction encompassed study characteristics and outcomes. Primary outcomes included thromboembolic events and bleeding within six months. Statistical analysis employed R software to assess heterogeneity and publication bias.

RESULTS: From the 121 articles screened, 12 were included in the study. These cohort studies, involving 20,644 participants, spanned from 2008 to 2022. While most studies were of good to high quality, some exhibited lower quality. Analysis favored oral anticoagulants (OAC) over single antiplatelet therapy (SAPT) for reducing bleeding risk (RR = 0.31, 95% CI: [0.11-0.87], P < 0.05), with moderate heterogeneity. Thromboembolic events did not significantly differ among interventions. Transient ischemic attacks and stroke outcomes were similar between SAPT and vitamin K antagonists (VKA). Six-month mortality rates were comparable between SAPT and VKA, with notable heterogeneity and higher mortality with SAPT in one study. Qualitative synthesis highlighted procedural success rates and bleeding complications across different interventions in transcatheter mitral valve repair studies.

CONCLUSION: OACs showed a lower risk of bleeding compared to antiplatelet therapies, while VKAs and OAC + SAPT may reduce thromboembolic events. No significant differences were found in stroke, TIA, or short-term mortality. These findings support individualized therapy and highlight the need for further randomized trials.

PMID:40849614 | DOI:10.1186/s12872-025-04974-4

BMC Nephrol. 2025 Aug 23;26(1):486. doi: 10.1186/s12882-025-04420-9.

ABSTRACT

BACKGROUND: Nephrotic syndrome is a common glomerular disorder. Treatment typically begins with corticosteroids, but patient response varies. Differentiating between steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS) early in the disease course is important, as SRNS is associated with a higher risk of poor long-term outcomes. Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker released in response to tubular injury, has emerged as a potential non-invasive marker for renal damage.

METHODS: We conducted a systematic review and meta-analysis of studies reporting NGAL levels in SSNS and SRNS, based on the PRISMA guidelines. A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, ScienceDirect, and the WHO Virtual Health Library Regional. The statistical analysis was performed using a random-effects model to estimate the standardized mean difference (SMD) with a 95% confidence interval.

RESULTS: A total of 16 studies were included. Meta-analyses revealed significantly higher urinary NGAL levels in both SSNS and SRNS patients compared to healthy controls. Urinary NGAL levels were significantly higher in SSNS and SRNS patients compared to healthy controls, with SMD = 0.78 (95% CI: 0.434-1.128, P < .001) and SMD = 2.56 (95% CI: 1.152-3.971, P < .001), respectively. Patients with SRNS had markedly higher urinary NGAL levels than those with SSNS (SMD = 1.889, 95% CI: 0.819-2.959, P < .001). ROC analyses across several studies demonstrated moderate to strong discriminative ability of urinary NGAL in distinguishing between SRNS and SSNS.

CONCLUSION: Urinary NGAL demonstrated strong potential as a non-invasive biomarker for distinguishing between SRNS and SSNS, supporting its clinical utility in early diagnosis, risk stratification, and management.

PMID:40849613 | DOI:10.1186/s12882-025-04420-9

BMC Pregnancy Childbirth. 2025 Aug 23;25(1):881. doi: 10.1186/s12884-025-07902-8.

ABSTRACT

BACKGROUND: Modern medicine has significantly transformed the process of childbirth among women. The preferred mode of childbirth has become of global interest to many researchers due to the steady rise in recent caesarean section (CS) rates. While CS is often viewed as a life-saving intervention, it is associated with both immediate and long-term complications for the mother, newborn, and future pregnancies. To better understand the medical and non-medical reasons for CS among women, this study was conducted to identify the socio-demographic and obstetric factors that influence CS in the Tamale Metropolis.

METHODOLOGY: A retrospective cross-sectional study was conducted among 318 postpartum mothers at the Tamale Teaching Hospital. Descriptive analysis, univariate logistic regression and stepwise multivariate logistic regression model were conducted, with a p-value < 0.05 considered statistically significant.

RESULTS: The majority of respondents (63.5%) were below 30 years. Almost all respondents (95.3%) were enrolled in the National Health Insurance Scheme (NHIS). The majority (95.91%) had single births. Most respondents (91.2%) had spontaneous vaginal delivery. The prevalence of CS was 8.8%. Significant factors influencing the preference for CS were maternal age above 30 years (aOR = 2.27, 95% CI = 1.01-5.12), rural settlement (aOR = 0.31, 95% CI = 0.10-0.92), twin delivery (aOR = 6.88, 95% CI = 1.64-28.95), and obstetric complication (aOR = 10.55, 95% CI = 2.42-46.04).

CONCLUSION: There is a need to focus on initiatives that address regional disparities, enhance access to comprehensive maternal healthcare services, and promote informed decision-making regarding mode of delivery to ultimately improve maternal and infant health outcomes.

PMID:40849612 | DOI:10.1186/s12884-025-07902-8